GHWA statement on migration and the International Code of Practice on the International Recruitment of Health Workers

The Global Health Workforce Alliance (GHWA) notes with anticipation the accelerated action being taken by the World Health Organization to negotiate a "Code of Practice" for the international recruitment of health personnel.

Since its inception, GHWA has clearly identified health worker migration as one of the fundamental issues to be addressed for the resolution of the health workforce crisis.

In May 2007, the Alliance convened and facilitated the Health Worker Migration Initiative, which worked with the World Health Organization in support of developing a framework for the Code.

In March 2008, the first Global Forum on Human Resources for Health - convened by the Alliance - endorsed the Kampala Declaration and Agenda for Global Action. Within these documents, migration, and the acceleration of a Code of Practice on the International Recruitment of health personnel were specified among the fundamental action strategies for resolution of the health workforce crisis.

The declaration states:

While acknowledging that migration of health workers is a reality and has both positive and negative impact, countries [are called] to put appropriate mechanisms in place to shape the health workforce market in favour of retention. The World Health Organization will accelerate negotiations for a code of practice on the international recruitment of health personnel.

The Agenda for Action underlines that:

  • Poorer countries are most affected by the loss of their already scarce health workforce to countries with better conditions and higher salaries;
  • There are increasingly competitive, cross-border pressures in the health sector. These include the growing demand from national health systems in rich countries as well as the growing trade and private commercial investment in health services;
  • In these circumstances, there is a need to find ways to stabilize the health workforce market and reduce the negative impacts of the high mobility of health professionals, thereby improving retention; and
  • Individuals have the right to leave any country, including their own, in search of better opportunities, but health workers trained with public resources have obligations as defined by individual countries.

Specific action points include that:

  • Governments will monitor health workforce flows in and out of countries, making such data transparently available and using this information to inform policy and management decisions;
  • The World Health Organization will accelerate negotiations for a code of practice on the international recruitment of health workers. This code should be a tool used by countries, regions and health professionals to negotiate agreements. Consistent with the agreed code of practice, destination countries should commit to supporting and enhancing the education and training of health workers both at home and in source countries. Actions should also be taken to realize the untapped potential of the health worker diasporas for improving health services in source countries;
  • All countries will work collectively to address current and anticipated global health workforce shortages. Richer countries will give high priority and adequate funding to train and recruit sufficient health personnel from within their own country;
  • National governments will be supported to develop coherent policies and build capacity to analyze the implications of trade agreements on the mobility of the health workforce. This effort will be informed by stakeholder consultation mechanisms within and outside government; and
  • Stakeholders will test and evaluate innovative interventions in the international health workforce market to assist retention.

As negotiations for the Code go forward, the Alliance urges that these action points are fully considered and included.

The Alliance particularly notes the need to ensure the capacity and commitment in both source and destination countries to collect essential data to enable the implementation of the Code and to support monitoring and evaluation of actions taken.

The Alliance underlines that if the issue of migration is not adequately addressed, countries will not be able to provide the health care needed for their populations. We welcome the current attention and action on this issue through the Code of Practice negotiations.

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